Volume 6, Issue 3, 1998
Review
Surgical strategies in severe abdominal infections
Marvaso Alberto
Initial treatment of peritonitis is largely standardised (elimination source of infection, debridement and intraoperative lavage) but a major problem is the management policy of patients who are at high risk of further infective complications after the initial operation. Existing prognostic scores based on physiological variables, age and chronic disease (APACHE II), and scores that include intraoperative information about the infection (MPI) unfortunately do not seem to be useful in identifying these patients.
Management of severe intra-abdominal infections is founded on three main principles: 1) supportive care of patient, 2 timely and appropriate antimicrobial therapy and 3) an operative treatment to aim at control the source of infection (evacuate pus, treat abdominal compartment syndrome) and prevent or treat persistant and recurrent infections.
In the patients with severe intrabdominal infection there is a great variance in surgical strategies but four may be distingued: continous postoperative peritoneal lavage, relaparotomy on demand (“wait and see” policy), open drainage (laparostomy) and planned relaparotomy. The continous postoperative peritoneal lavage and relaparotomy on demand do not seem to prevent residual o recurrent intrabdominal infections and are associated with a high mortality. The planned relaparotomy seem to decrease the rate of residual peritoneal infection but has a high complication rate. It may be concluded that the ideal operative approach for patients with severe intra-abdominal infection has not been established yet. However, these techniques to be beneficial must be performed in well-selected patients and performed by a team of dedicated surgeons.
Cryptosporidium infection in immunocompetent and immunocompromised host
Maisto Angela,
Mogavero Anna Rita,
Gaeta Giovanni Battista
Prior to 1980 infections with Cryptosporidium species were considered extremely rare in humans. During the eighties, evidence cumulates that this intracellular protozoan was often responsible of self-limiting diarrheal illness in immunocompetent patients and of a prolonged, life-threatening disease in immunocompromised hosts, especially patients with AIDS.
The aim of this paper is to review the present knowledge on Cryptosporidium biology, epidemiology, pathogenesis, diagnosis, therapy and highlight recent studies on the clinical aspects of this infection.
Original article
Observations about the treatment of Cytomegalovirus retinitis in patients with HIV infection using Ganciclovir and Foscarnet
Drenaggi Davide,
Pauri Paola,
Sigismondi Carlo,
Nuzzo Milva Maria,
Mariwan Izat,
Schimizzi Anna Maria,
Cirioni Oscar,
Brugia Marina,
Scalise Giorgio
Objective: The Authors report their experience of Cytomegalovirus (CMV) retinitis therapy in HIV patients, using Ganciclovir and Foscarnet in monotherapy. They also evaluate the reliability of the Polymerase Chain Reaction (PCR) through the qualitative technique as an index of active disease.
Methods: 18 patients suffering from CMV retinitis were treated: Ganciclovir was administered at a dosage of 10 mg/kg b.w./day and Foscarnet at 180 mg/kg b.w./day, both of them for 21 days during the induction phase. During the mantainance phase the former was administered at 5 mg/kg b.w./day and the latter at 90 mg/kg b.w./day for 5 days a week. Results: Both the drugs induced the stabilization or regression of the lesions. There was however a relapse with both therapies. We did not observe a significant difference either in the entity and the duration of the stabilization or in the survival from diagnosis time. Finally the PCR method was not helpful in the diagnosis of CMV retinitis.
The behaviour of plasma triglycerides and cholesterol in HIV positive haemophiliacs
Cecconi Nadia,
Carducci Anna Laura,
Vincenti Antonella,
Luchi Sauro,
Scasso Antonio
Hypertriglyceridemia has frequently been found both in subjects with AIDS and in asymptomatic HIV-positive ones. In order to evaluate the importance of hyperlipemia as an index of the clinical evolution of HIV infection, the levels of triglycerides, total cholesterol and CD4 lymphocytes were determined over a period of 2 years in 8 haemophiliacs with AIDS, 13 asymptomatic HIV-positive and 45 HIV-negative haemophiliacs attending the Operative Unit of Coagulation Disorders of the University of Pisa. The mean concentration of triglycerides and incidence of hypertriglyceridemia were significantly higher in haemophiliacs with AIDS, compared with HIV-negative subjects (p<0.0001), while the triglycerides values of asymptomatic HIV-positives fell between those of the other groups.
Cholesterol levels were lower in HIV-positive haemophiliacs and in those with AIDS compared with HIV-negatives. No correlation was found between triglyceride levels and those of CD4 lymphocytes.
Human and animal brucellosis in Caltagirone (CT) area: epidemiological features
Bellissima Pietro,
Parrinelli Nicola,
Bonfante Salvatore
The Authors report an epidemiological investigation about human and animal brucellosis, during 1993-97, in Caltagirone (CT) area. A remarkable increase of the cases of human brucellosis related to the increase of ovine-caprine brucellosis cases because of particular climatic conditions during 1996 (morbility index 61 x 100.000 residents) is reported. Despite the great endeavour of the Veterinary Service of District, the results of prophilaxis of ovine-caprine brucellosis are modest.
Looking forward to the eradication of the animal brucellosis, it is necessary to intervene on the market of the milk and its products to decrease the human brucellosis.
Case report
Association of visceral Leishmaniosis and pulmonary tuberculosis: description of a patient
Montefusco Silvana,
Gallotta Giovanni,
Lamenza Francesco,
De Renzo Amalia,
Postiglione Alfredo
Leishmaniosis, whether localised or disseminated, is mainly correlated to cell-mediated immunodeficiency. Immunodeficient patients are also particularly prone to diseases due to Mycobacterium tuberculosis, in whom either the disseminated form or a localisation of the lungs prevails. We report a rather uncommon association of both pathologies successufully treated with N-methylglucamine antimonium followed by an association of rifampycin, isoniazid and ethambutol. The ethiopathogenetic mechanisms, are described.
The Infections in the History of Medicine
The Costantin Von Economo’s lethargic encefalitis
Pistacchio Eleonora
Starting from the Constantin Von Economo’s description of a “new” disease, the lethargic encephalitis, the author delineates the history of an infectious sleeping sickness that caused epidemics in Europe from 1917 to 1928 and led to create, in Italy, the “Institutes for Encephalitis”.
